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India begins controlled trials of plasma therapy – Hindustan Times

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Trials using the antibody-rich blood of patients cured of the coronavirus disease (Covid-19) have begun, with doctors turning to a pool of 1,600 people in India who have recovered from the infection to test their antibodies as a potential cure for those fighting the disease.

Convalescent plasma therapy uses a blood component called plasma — which contains the virus-fighting antibodies – from people who have recovered from the infection to treat those who are severely ill with Covid-19.

Apart from the Indian Council of Medical Research – India’s apex health research body – at least two hospitals have applied to test the effectiveness of the therapy in Delhi, the protocols for which have been established .

The Institute of Liver and Biliary Sciences, an autonomous Delhi government hospital, has already received approval to conduct the trials. The private Max Hospital is awaiting approval to launch the trials.

“As the same product will be tested across the centres, the approvals are being given to hospitals that conform with the ICMR protocols so that uniform and comparable data is generated from across centres,” said an official from the Central Drugs Standard Control Organisation (CDSCO), the apex drug regulator.

When the virus enters the human body, the immune system creates an antibody to fight it. This antibody remains in a person even after the virus has cleared out of their system. In the absence of other drugs, experts say that using these antibodies from recovered patients can offer a reprieve to severely ill Covid-19 patients.

“Now, there are over 1,000 people who have recovered from Covid-19 in the country and their blood plasma can be used to treat those who are critical. The antibodies from the recovered person will theoretically help the critical patients in fighting the infection. This is done for other viral illnesses as well,” said Dr SK Sarin, director of the Institute of Liver and Biliary Sciences

The therapy would be given only to patients in a critical condition — those with a respiratory rate higher than 30 breaths per minute (the normal is 18-20 breaths per minute), have oxygen saturation of less than 90% (normal is 95 to 100%), or have infiltrates like pus in the lungs.

As for donors, only health individuals – with no comorbidities like diabetes, hypertension, or heart disease and less than 60 years of age – who have recovered from the infection would be selected.

“There are anecdotal evidences to say that Covid-19 patients on plasma therapy have recovered in other countries. However, we need to ensure that the therapy is given to people who are at high risk before they are on a ventilator. This is because the antibodies can prevent the progression of the disease by reducing the viral load, it cannot heal the lungs and the other organs. So, if a person already has lung damage and is in multi-organ failure then the therapy will not be useful,” said Dr Shobha Broor, former head of the department of microbiology at the All India Institute of Medical Sciences.

For the treatment, a plasmapheresis machine is used to derive plasma from the blood, which is then administered to the patients with severe infection. This method is, however, not new and is used for the treatment of several other diseases.

And experts feel that not giving the treatment to half the patients under randomised control trial is unethical. “Plasma therapy is already being used for three categories of ailments – one is viral infection such as hepatitis or even chicken pox that can be severe in immuno-compromised patients; two, it is done for autoimmune disorders, and three, conditions like haemophilia in which the people receive proteins other than antibodies – like factor 8 in this case – through plasma therapy,” said Dr T Jacob John, professor emeritus and former head of the department of virology at Christian Medical College, Vellore.

“When it is an already established procedure, why should it not be administered to all the patients who are very sick?. Not giving it to half the patients in need is actually an ethical problem, I feel,” he said.

In a randomised control trial, which is suggested by the ICMR, half the patients receive the plasma and the other half receive a placebo. This helps the doctors in determining whether people on therapy do better than those not on it.

A recently published report on a trial in China showed an improvement in the clinical conditions of 10 people who received the therapy. “All symptoms in the 10 patients, especially fever, cough, shortness of breath, and chest pain, disappeared or largely improved within 1 day to 3 day upon Convalescent Plasma transfusion,” the study published in PNAS Journal said.

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Canada to donate up to 200,000 vaccine doses to combat mpox outbreaks in Africa

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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.

It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.

Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”

Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.

Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.

A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.

On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.

Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”

But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”

“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.

Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.

Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.

Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.

“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.

“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”

This report by The Canadian Press was first published Sept. 13, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

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HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.

The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.

Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.

“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”

The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.

A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.

Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.

“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.

Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.

The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.

“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.

This report by The Canadian Press was first published Sept. 11, 2024.

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Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

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ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.

Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.

Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.

Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.

The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.

“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.

Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.

Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.

Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.

A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.

This report by The Canadian Press was first published Sept. 10, 2024.

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